Nearly two-thirds of all medical imaging procedures in the United States are performed in physician offices, yet few of these small healthcare providers can afford picture archiving and communication systems (PACS) needed to exchange these images with large hospitals. Without online access to previous imaging tests many procedures are repeated, leading to excessive healthcare costs. The Government Accountability Office (GAO) has estimated that these costs doubled between 2000 and 2006, and that imaging currently accounts for over one third of total Medicare payments to office-based cardiologists. To facilitate cross-provider sharing of medical images we propose a strategic partnership between Heart Imaging Technologies, the Johns Hopkins Health System, and Duke University to develop a medical image management system for use by physician offices that interfaces to the National Health Information Network (NHIN), a Federal initiative of the Office of the National Coordinator for Health Information Technology (ONC). The system we propose will allow multiple small healthcare providers to transmit images over the Internet to a single service provider, and then share these images with other healthcare providers using the NHIN infrastructure. The proposed system is expected to greatly facilitate cross-provider exchange of medical images, thereby reducing repeat testing, reducing healthcare costs, and improving the quality of patient care on a national scale.